Sources of Papal Authoritative Teaching on Matters of Conscience for Pharmacists
by Edward M DeSimone II, PhD, RPh
Dear Marie N,
I have added my thoughts on this issue below. It is a bit wordy but the issue is a complex one. However, this is only one logical conclusion.
I would suggest reading Evangelium Vitae, specificically part 74. The link is here. http://www.vatican.va/holy_father/john_paul_ii/encyclicals/documents/hf_jp-ii_enc_25031995_evangelium-vitae_en.html
I will quote one small part. I copied the entire section of part 74 at the very bottom of this e-mail. Pope John Paul 2nd wrote this concerning material cooperation:
"Such cooperation occurs when an action, either by its very nature or by the form it takes in a concrete situation, can be defined as a direct participation in an act against innocent human life or a sharing in the immoral intention of the person committing it. This cooperation can never be justified either by invoking respect for the freedom of others or by appealing to the fact that civil law permits it or requires it. (my emphasis)
"To refuse to take part in committing an injustice is not only a moral duty; it is also a basic human right."
I believe that this is clear. If we believe that abortion, dispensing of emergency abortifacients, etc. constitute murder (an immoral act), we are obligated to refuse to participate even if civil law requires that participation. Mandatory participation laws and/or executive orders and the judges who enforce them are in fact committing religious discrimination because they are trying to force health care providers like pharmacists to commit acts that violate their religious beliefs. This is clearly unconstitutional.
Ethics codes are generally vague. That is why this issue was addressed by the APhA House of Delegates as a specific policy statement. The following policy sets a higher professional standard than does the Code of Ethics. As a matter of fact, the Code of Ethics is being used by the other side to say that pharmacists need to do for the patient whatever the patient wants.
With the passing of law’s that have the capacity to infringe upon a pharmacist’s moral, religious, and ethical beliefs (such as the legalization of euthanasia in Oregon), the House of Delegates of the American Pharmacists Association (APhA) decided to address this issue. In 1998, the House of Delegates passed the following policy: (Pharmacist Conscience Clause)
APhA recognizes the individual pharmacist’s right to exercise conscientious refusal and supports the establishment of systems to ensure patient’s access to legally prescribed therapy without compromising the pharmacist’s right of conscientious refusal. (my emphasis)
Please note that this policy statement looks like an "Oreo". It affirms the pharmacist's right of conscientious refusal and states that systems should be in place to assist the patient. However, no system should impinge on the pharmacist's right to refuse. This is crucial since it says that pharmacists do not have to be involved in material cooperation. I am a long time member of the APhA House of Delegates and was involved in the debate and wording of this policy.
A judge in Springfield, Illinois, recently ruled against the Governor of Illinois (and for pharmacists) regarding the protecting against recrimination to pharmacists for refusing to dispense Plan B. I would review this ruling.
Many states have laws which protect health care providers against recrimination for refusing to participate in abortion. I would argue that Plan B and others are abortifacients. One of the most contentious areas of debate currently is the issue of Plan B® (levonorgestrel). Medical researchers are divided on the mechanism of action of this drug. According to Clinical Pharmacology 2000 (an online medical/pharmacy drug information resource), “The exact mechanism of action, however, is unknown.” It goes on to say “…additional mechanisms may be involved.”(1) Another medical/pharmacy reference, MICROMEDEX, in discussing the mechanism of action of levonorgestrel states that “It also inhibits implantation via alteration of the endometrium.”(2) In a recent search of the medical literature (Medline), a 2007 paper discussing the action of levonorgestrel as an emergency contraceptive concluded “The mechanism of action of LNG (levonorgestrel) as EC (emergency contraceptive) remains unknown.”(3) The medical literature is replete with such statements. If medical researchers cannot define a single mechanism of action or state unequivocally that the drug’s mechanism of action is not as an abortifacient, then pharmacists (as well as all health care providers) who oppose abortion must exercise their right of conscience and refuse to participate.
Closing comments: Pharmacists are health care providers who, as part of their professional responsibilities, must review each and every prescription for therapeutic correctness and efficacy. Pharmacists have traditionally held a strong professional relationship with their patients. Presently, we often forget that the pharmacist also has a responsibility to the unborn child. Many states, for example, have enacted laws protecting unborn children as well as laws that punish people for killing two persons when a pregnant woman is killed. The use of drugs like Plan B is an abnormal termination of a natural process (pregnancy). It is also the murder of an unborn child is the drug acts by preventing implantation of a fertilized ovum. Until medical research proves otherwise, conscientious refusal to dispense is the only viable option for pharmacists who object on moral, ethical or religious grounds. To require participation in an act that is morally reprehensible is tantamount to religious discrimination.
(1) Clinical Pharmacology. Levonorgestrel. Tampa, FL: 2007 Gold Standard Inc.; 2007.
(2) MICROMEDEX. Levonorgestrel. New York: Thomson Health Care; 2007.
(3) do Nascimento JA, Seppala M, Perdigao, et al. In vivo assessment of the human sperm acrosome reaction and the expression of glycodelin-A in human endometrium after levonorgestrel-emergency contraceptive pill administration. Hum reprod. 2007;22(8):2190-5.
I hope that provides you with some additional nsights. If you have any questions, please feel free to contact me.
"What is taking place in America is a war against the child. And if we accept that the mother can kill her own child, how can we tell other people not to kill one another." Mother Theresa 2/97
Edward M. DeSimone II, R.Ph., Ph.D.
Professor of Pharmacy Sciences
"The Official Professor of the 21st Millennium"
School of Pharmacy and Health Professions
2500 California Plaza
Omaha, NE 68178
One Nation, Under God
74. The passing of unjust laws often raises difficult problems of conscience for morally upright people with regard to the issue of cooperation, since they have a right to demand not to be forced to take part in morally evil actions. Sometimes the choices which have to be made are difficult; they may require the sacrifice of prestigious professional positions or the relinquishing of reasonable hopes of career advancement. In other cases, it can happen that carrying out certain actions, which are provided for by legislation that overall is unjust, but which in themselves are indifferent, or even positive, can serve to protect human lives under threat. There may be reason to fear, however, that willingness to carry out such actions will not only cause scandal and weaken the necessary opposition to attacks on life, but will gradually lead to further capitulation to a mentality of permissiveness.
In order to shed light on this difficult question, it is necessary to recall the general principles concerning cooperation in evil actions. Christians, like all people of good will, are called upon under grave obligation of conscience not to cooperate formally in practices which, even if permitted by civil legislation, are contrary to God's law. Indeed, from the moral standpoint, it is never licit to cooperate formally in evil. Such cooperation occurs when an action, either by its very nature or by the form it takes in a concrete situation, can be defined as a direct participation in an act against innocent human life or a sharing in the immoral intention of the person committing it. This cooperation can never be justified either by invoking respect for the freedom of others or by appealing to the fact that civil law permits it or requires it. Each individual in fact has moral responsibility for the acts which he personally performs; no one can be exempted from this responsibility, and on the basis of it everyone will be judged by God himself (cf. Rom 2:6; 14:12).
To refuse to take part in committing an injustice is not only a moral duty; it is also a basic human right. Were this not so, the human person would be forced to perform an action intrinsically incompatible with human dignity, and in this way human freedom itself, the authentic meaning and purpose of which are found in its orientation to the true and the good, would be radically compromised. What is at stake therefore is an essential right which, precisely as such, should be acknowledged and protected by civil law. In this sense, the opportunity to refuse to take part in the phases of consultation, preparation and execution of these acts against life should be guaranteed to physicians, health-care personnel, and directors of hospitals, clinics and convalescent facilities. Those who have recourse to conscientious objection must be protected not only from legal penalties but also from any negative effects on the legal, disciplinary, financial and professional plane.
"Thou shalt love thy neighbour as thyself" (Lk 10:27):" promote" life
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